Socioeconomic characteristics, tobacco use, and service utilization by county poverty status among Oklahoma tobacco helpline registrants: A cross-sectional study.

INTRODUCTION

Residents of counties with higher poverty levels experience elevated smoking rates and disproportionate tobacco-related cancer mortality. This study examined differences in sociodemographic characteristics, tobacco use, and service utilization among Oklahoma Tobacco Helpline (OTH) registrants across county poverty designations.

METHODS

In this cross-sectional study, data were analyzed from 33847 adults registered with the OTH between 1 July 2023 and 30 June 2024. Counties were classified as persistent poverty (PPC: ≥20% of residents in poverty for ≥30 years), current poverty (CPC: ≥20% of residents in poverty currently for <30 years), or non-poverty (NPC: <20% of residents in poverty). Group differences were examined using the chi-squared test and analysis of variance. Adjusted multinomial logistic regression analyses evaluated associations between poverty status, tobacco use, and service utilization, controlling for age, sex/gender, race, education level, household income, health insurance, and chronic conditions.

RESULTS

Registrants residing in PPCs and CPCs differed from those in NPCs in terms of age and race, and they had lower education, income, and greater Medicaid coverage (all P<0.05). In adjusted models, PPC registrants had higher odds of smoking >1 pack/day (heavy smoking) (AOR=1.49; 95% CI: 1.30-1.70; p<0.001) and learning about OTH through personal networks (AOR=1.42; 95% CI: 1.16-1.73; p<0.001) compared with NPCs. Compared with registrants residing in non-poverty counties (NPCs), CPC registrants had higher odds of smoking >1 pack/day (AOR=1.39; 95% CI: 1.16-1.65; p<0.001) and learning about OTH through community/social organizations (AOR=1.77; 95% CI: 1.33-2.35; p<0.001). Service type and nicotine replacement therapy receipt/duration were similar across poverty designations.

CONCLUSIONS

PPC and CPC registrants showed greater socioeconomic disadvantage and nicotine dependence than NPC registrants but had distinct information pathways. These findings highlight geographically concentrated poverty as a potential contributor to tobacco-related disparities and suggest that interventions addressing social and environmental conditions in PPCs may help enhance cessation engagement and reduce tobacco-related inequities.